Impact of lymph node dissection at the time of radical nephrectomy with tumor thrombectomy on oncological outcomes: Results from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC)
Por:
Tilki, D, Chandrasekar, T, Capitanio, U, Ciancio, G, Daneshmand, S, Gontero, P, Gonzalez, J, Haferkamp, A, Hohenfellner, M, Huang, WC, Espinos, EL, Lorentz, A, Martinez-Salamanca, JI, Master, VA, McKiernan, JM, Montorsi, F, Novara, G, Pahernik, S, Palou, J, Pruthi, RS, Rodriguez-Faba, O, Russo, P, Scherr, DS, Shariat, SF, Spahn, M, Terrone, C, Vera-Donoso, C, Zigeuner, R, Libertino, JA, Evans, CP
Publicada:
1 feb 2018
Resumen:
Objectives: To study the effect of lymph node dissection (LND) at the time of nephrectomy and tumor thrombectomy on oncological outcomes in patients with renal cell carcinoma (RCC) and tumor thrombus.
Patients and methods: The records of 1,978 patients with RCC and tumor thrombus who underwent radical nephrectomy and tumor thrombectomy from 1985 to 2014 at 24 centers were analyzed. None of the patients had distant metastases. Extent and pathologic results of LND were compared with respect to cancer-specific survival (CSS). Multivariable Cox regression models were used to quantify the effect of multiple covariates.
Results: LND was performed in 1,026 patients. In multivariable analysis, the presence of LN metastasis, the number of positive LNs, and LN density were independently associated with cancer-specific mortality (CSM). Clinical node-negative (cN-) disease was documented in 573 patients, 447 of them underwent LND with 43 cN- patients (9.6%) revealing positive LNs at pathology. LN positive cN- patients showed significantly better CSS when compared to LN positive cN+ patients. In multivariable analysis, positive cN status in LN positive patients was a significant predictor of CSM (HR, 2.923; P = 0.015).
Conclusions: The number of positive nodes harvested during LND and LN density was strong prognostic indicators of CSS, while number of removed LNs did not have a significant effect on CSS. The rate of pN1 patients among clinically node-negative patients was relatively high, and LND in these patients suggested a survival benefit. However, only a randomized trial can determine the absolute benefit of LND in this setting. Copyright (C) 2018 Elsevier Inc. All rights reserved.
Filiaciones:
Tilki, D:
Univ Calif Davis, Sch Med, Dept Urol, Sacramento, CA 95817 USA
Chandrasekar, T:
Univ Calif Davis, Sch Med, Dept Urol, Sacramento, CA 95817 USA
Capitanio, U:
Univ Vita Salute, Hosp San Raffaele, Dept Urol, Milan, Italy
Ciancio, G:
Univ Miami, Miami Transplant Inst, Dept Urol, Miami, FL USA
Daneshmand, S:
USC Norris Comprehens Canc Ctr, Dept Urol, Los Angeles, CA USA
Gontero, P:
Univ Turin, AOU San Giovanni Battista, Dept Urol, Turin, Italy
Gonzalez, J:
Hosp Cent Cruz Roja San Jose & Santa Adela, Dept Urol, Madrid, Spain
Haferkamp, A:
Goethe Univ Frankfurt, Dept Urol, Frankfurt, Germany
Hohenfellner, M:
Heidelberg Univ, Dept Urol, Heidelberg, Germany
Huang, WC:
NYU, Dept Urol, Sch Med, New York, NY 10003 USA
Espinos, EL:
Hosp Univ Infanta Sofia, Dept Urol, Madrid, Spain
Lorentz, A:
Emory Univ, Dept Urol, Atlanta, GA 30322 USA
Martinez-Salamanca, JI:
Univ Autonoma Madrid, Hosp Univ Puerta Hierro Majadahonda, Dept Urol, Madrid, Spain
Master, VA:
Emory Univ, Dept Urol, Atlanta, GA 30322 USA
McKiernan, JM:
Columbia Univ, Coll Phys & Surg, Dept Urol, New York, NY USA
Montorsi, F:
Univ Vita Salute, Hosp San Raffaele, Dept Urol, Milan, Italy
Novara, G:
Univ Padua, Dept Urol, Padua, Italy
Pahernik, S:
Heidelberg Univ, Dept Urol, Heidelberg, Germany
Palou, J:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Pruthi, RS:
UNC Chappel Hill, Dept Urol, Chapel Hill, NC USA
Rodriguez-Faba, O:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Russo, P:
Mem Sloan Kettering Canc Ctr, Dept Surg, Urol Serv, 1275 York Ave, New York, NY 10021 USA
Scherr, DS:
Weill Cornell Med Ctr, Dept Urol, New York, NY USA
Shariat, SF:
Med Univ Vienna, Vienna Gen Hosp, Dept Urol, Vienna, Austria
Spahn, M:
Univ Wurzburg, Dept Urol, Wurzburg, Germany
Univ Hosp Bern, Dept Urol, Bern, Switzerland
Terrone, C:
Univ Piemonte Orientale, Maggiore della Carita Hosp, Div Urol, Novara, Italy
Vera-Donoso, C:
Hosp Univ & Politecn La Fe, Dept Urol, Valencia, Spain
Zigeuner, R:
Med Univ Graz, Dept Urol, Graz, Austria
Libertino, JA:
Lahey Clin Fdn, Dept Urol, Burlington, MA USA
Evans, CP:
Univ Calif Davis, Sch Med, Dept Urol, Sacramento, CA 95817 USA
Green Accepted
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